Diagnosis of transverse dentoalveolar anomalies
Diagnosis of
Dentoalveolar anomalies of the transverse direction
3rd year course
Doctor KHALED KHODJA
Plan
Introduction
1-Terminology
2- Clinical forms
– Maxillary anomalies
– Maxillary endoalveolism
– Maxillary exoalveolia
– Mandibular anomalies
– Mandibular endoalveolitis
– Mandibular exoalveolia
– Facial symmetry disorders
– Functional lateral deviation
Conclusion
Bibliography
Introduction
- Basal anomalies of the transverse direction will be the subject of particular attention on the part of the orthodontist because of their impact on the other directions (vertical and sagittal direction) as well as the difficulty of diagnosis.
DEFINITION
- These anomalies correspond to occlusion disorders in the vestibulo-lingual direction of alveolar origin located at the level of the lateral sectors. These anomalies are either maxillary or mandibular, symmetrical or asymmetrical, they can be isolated or associated with other anomalies. These morphological anomalies can be accompanied by kinetic anomalies; Laterodeviation
- Note: The diagnostic study of dentoalveolar anomalies of the transverse direction based on
clinical examination
X-ray examination
the study of casts (indices and measurements).
Clinical forms.
- Dentoalveolar anomalies of the transverse direction at the maxillary level:
- -Symmetrical endoalveolus with unilateral or bilateral crossbite
- -Asymmetric endoalveolus with unilateral linguocclusion without laterodeviation
- -Maxillary exoalveolism
- Dentoalveolar anomalies of the transverse direction at the mandibular level: –
- Mandibular endoalveolitis
- – Mandibular exoalveolism
- Laterodeviations
Maxillary endoalveolitis
– Definition :
- Maxillary endoalveolism corresponds to an insufficiency of the transverse development of the alveolar processes characterized by a normal inclination of the molars and premolars, associated or not with maxillary incisal crowding.
- – Symmetrical maxillary endoalveolism with bilateral linguocclusion
- Facial signs
– Little marked in light forms.
– In severe cases, there is a thinning and lengthening of the face.
- Occlusal signs
– Separate arcades:
-Maxillary arch: the palatine vault is symmetrical and sometimes relatively deep (ogival) but this sign is very inconsistent)
-Significant maxillary incisal crowding;
– Absence of abrasion of the milk canines and the right and left supporting cusps of the temporary teeth
– Mandibular arch of usual shape, without notable incisal crowding,
Associated DDM.
Diagnosis of transverse dentoalveolar anomalies
- Inter-arcade layout:
– In temporary dentition: bilateral crossbite is a sign of maxillary endoalveolism.
– In permanent dentition
– Bilateral linguocclusion in ICM.
– Coincidence of incisal media in RC and ICM.
– Rare mandibular laterodeviation, except in the presence of a lateral incisor in linguocclusion.
Diagnosis of transverse dentoalveolar anomalies
Bilateral maxillary endoalveolis Maxillary endoalveolis associated with mandibular laterodeviation
with an ogival palace
- Asymmetric endoalveoli :
Observed by lack of stimulation of the growth of the upper jaw (atypical swallowing – unilateral chewing)
Facial signs not very marked unlike endognathia where we observe:
– Facial deformations due to flattening on the endognathic side.
– Convergence of the eyebrow and commissural lines on the affected side
Occlusal signs
– Unilateral linguocclusion in ICM on the affected side
-Functional signs:
– Mouth breathing or mixed breathing with mouth predominance, due to nasal obstruction
(adenoid vegetation) or tonsillar hypertrophy.
– Atypical swallowing with tongue spreading between the arches
Teleradiographic signs:
-in profile: if the maxillary endoalveolus is isolated, no changes are observed, except sometimes an increase in the DV
-The front incidence highlights:
– Decrease in maxillary width.
– Decrease in nasal width.
– Normal mandibular arch.
Diagnosis of transverse dentoalveolar anomalies
- Etiology:
– Genetics: Crouzon syndrome, cleft lip and palate
– Absence of lingual stimulation. (atypical swallowing)
– Unilateral or bilateral nasal obstruction.
– trauma to the maxillary region
-A maxillofacial infection; having caused an osteo-muscular deficit such as
early maxillary osteitis and sinusitis
- One-sided chewing
Diagnosis of transverse dentoalveolar anomalies
- Differential diagnosis of maxillary endoalveolism
-Maxillary endognathism
– Mandibular exoalveolism
– Mandibular exognathism
– Laterodeviation of the mandible
Maxillary exoalveolia
- Maxillary exoalveoli:
Uncommon anomaly inseparable from mandibular endoalveolism. It can be aggravated in association with BRODIE syndrome causing total inocclusion
A) Positive diagnosis:
– Exoalveolia can be unilateral or bilateral.
Unilateral exoalveolia
- It is exceptional and is a case of hemi facial hypertrophy. The clinical signs of the condition are very marked.
- Bilateral exoalveolia
It is characterized by:
– A wide and short face
– Prominent cheekbones.
– A vertical implantation of the lateral teeth on a wide base.
– Significant overbite.
– Mandible inscribed in the maxilla.
Severe bilateral endoalveolitis associated with DDM due to macrodontia May also suggest mandibular exoalveolitis
Diagnosis of transverse dentoalveolar anomalies
Nasal ventilation and high tongue posture and (a and b). Oral ventilation and low tongue posture
– Atypical swallowing with lingual interposition hinders development
Mandibular endoalveolitis
- Mandibular endoalveolitis
In general, it is the retroposition associated with mandibular endoalveolism that suggests mandibular endognathism, which means that this anomaly does not exist in its pure state. It is characterized by:
- Lower floor decreased,
- vestibuloclusion of the maxillary lateral sectors
Mandibular exoalveolus
- Mandibular exoalveolus
-Less frequent anomaly, characterized by:
– A mandible that is too wide, making it visible on the face.
– A large, low and forward tongue.
– A vestibuloclusion of the lower teeth
- Etiology of mandibular exoalveoli:
– Low lingual position
– Macroglosssia – Ankyloglossia
– Exaggerated transverse expansion
– Genetics: hemi facial hypertrophy
- – Differential diagnosis
-Maxillary endoalveolitis
-maxillary endognathism
– Mandibular exognathism
Mandibular laterodeviation
Facial symmetry disorders:
Functional lateral deviation:
It is a kinetic anomaly of the position of the mandible without affecting its shape.
It is characterized by:
-At rest; perfect facial symmetry, parallelism between the horizontal lines (bi-eyebrow, bi-pupillary and bi-commissural), normal lip relationships and coincidence of the medial frenulum and the incisal midpoints, with the PSM
-In occlusion; lateral deviation of the chin , convergence of the horizontal lines on the side of the deviation with lateral deviation (right or left) of the lower median and transverse occlusal disharmony.
– Teleradiographic signs (Frontal incidence):
– At rest: The mandible is of normal width and symmetrical, as are the structures of the base of the skull and the maxilla.
– In ICM: Lateral deviation of the chin and the lower incisor middle
Etiology:
-Premature contact or single or multiple deflective interference
-Symmetrical maxillary endoalveolism
– Differential diagnosis:
– Mandibular laterognathia
-Dental lateral deviation
Severe mandibular laterodeviation
It is an asymmetrical structural deformation resulting in a deviation of the lower incisor middle of skeletal origin.
It is characterized by; facial repercussions with convergence of horizontal lines (bi-eyebrow, bi-pupillary, bi-commissural) towards the affected side, permanent lateral deviation of the body of the mandible, unilateral reverse occlusion and deviated incisal midpoints in ICM and RC.
It may be due to:
– Unilateral condylar hypertrophy.
– Transverse hypertrophy of the body
– Transverse and vertical hypertrophy of the entire hemimandible.
– Hemi mandibular atrophy
- Differential diagnosis:
-mandibular laterognathia
– unilateral exoalveoli
– Unilateral maxillary endognathia and endoalveolitis
– dental deviations
– Basicranial damage (plagiocephaly)
– Spinal injuries (torticollis
Indices and measurements
Radiological examination
Conclusion
- Transverse dentoalveolar dysmorphoses are most often found
- combined with a dysmorphosis of the sagittal and/or vertical direction. Note also that sometimes
- alveolar compensations may mask a skeletal abnormality; which
- considerably complicates the diagnosis.
Bibliography
- 1) Antonio Patti, Guy Perrier d’Arc. Early Orthodontic Treatments. Paris:
- Quintessence International, October 2003. 121 P.
- 2) BASSIGNY.F; Manual of dentofacial orthopedics; MASSON.1983
- 3) Marie-José Boileau; Orthodontics for children and young adults Volume 1; Elsevier Masson 2011
Diagnosis of transverse dentoalveolar anomalies
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